SUDDEN CARDIAC ARREST and THE VALUE OF CPR

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Sudden Cardiac Arrest is one condition that contributes to significant mortality in the adult population, with major and catastrophic psychological and emotional effects on the family. And unlike the usual chronic diseases that contribute to mortality and morbidity, Sudden Cardiac Arrest is an unpredictable condition. Like a thief in the night, it strikes without warning, leaving relatives of victims with tremendous psychological and emotional burden.

Today, it remains the single largest categoric cause of natural death in the United States. In the Philippines, with heart diseases being the most common cause of death (accounting for close to 20 percent of all deaths according to the recent Department of Health statistics) among adults, it would be no surprise if this condition constituted the predominant mode of death of most cardiac diseases. In fact, approximately half of all deaths from heart diseases occur as Sudden Cardiac Arrest. It can happen at any time, to anyone, anywhere, and although pre-existing heart disease is a common cause, it may strike people with no history of cardiac disease or symptoms.

The most common setting is when the heart goes into a sudden fatal arrhythmia called ventricular fibrillation- wherein the heart goes into a very rapid and chaotic rhythm, causing the normal rhythmic contractions to stop, and causing inability of the heart to pump blood and oxygen to the rest of the body. Within seconds, the brain becomes depleted of oxygen and the person loses consciousness. If not treated immediately, the heart ultimately stops beating, and the person dies.

Despite advances in emergency medical systems and in the technology of resuscitation, Sudden Cardiac Arrest remains a major public health problem. It is associated with low survival rate, and major long term severe mental impairment due to delays in cardiopulmonary resuscitation (CPR) and treatment.

When someone has a sudden cardiac arrest, his or her survival depends greatly on immediately getting CPR from a bystander. CPR must begin within 4 to 6 minutes and advanced life support measures must begin within 8 minutes, to avoid brain death. In Remonde’s case, the 1 to 2 hour interval from the time that he was found unconscious to the time he was brought to the hospital to be evaluated was too long. Each minute in delay of resuscitative measures decreases the chances of survival by nearly 10%.

Studies have shown that effective CPR done immediately after cardiac arrest can double a victim’s chance of survival. CPR is a simple life-saving technique consisting of repetitive chest compressions and mouth to mouth breathing, which forms a vital link in the emergency management during an episode of cardiac arrest. It significantly improves survival and contributes to preservation of heart and brain function. In fact, most studies have shown that patients in whom early CPR was instituted have lesser neurologic dysfunction and higher survival compared to those in whom CPR was done late.

A great bulk of these cardiac arrests occur outside of the hospital setting. According to the American Heart Association, almost 80 percent of out-of-hospital cardiac arrests occur at home and are witnessed by a family member. Unfortunately, less than 10 percent of victims survive because the vast majority of those witnessing the arrest are people who do not know how to perform CPR. Surveys reveal that majority of bystanders who might have an idea about how to do CPR are worried that they might do something wrong or make things worse. Moreover, a lot of these individuals are a bit apprehensive about giving mouth to mouth resuscitation for fear of disease transmission from an unknown victim.

During a cardiac arrest, CPR is important because it is the best treatment for cardiac arrest until the arrival of a Defibrillator, a special medical equipment which delivers an electrical shock to the patient’s chest and restores the heartbeat to its normal rhythm. In majority of episodes of sudden cardiac death, early use of the defibrillator is key to the survival of the victim. Unfortunately, unlike developed countries like the United States and even our Southeast Asian neighbors such as Singapore and Japan which have a universally established emergency medical response system and have instituted public access defibrillation wherein this equipment is made available in public institutions for use by lay responders during emergencies, defibrillators are not readily available in the Philippines except in hospitals and selected buildings. Hence, usually the only way that early defibrillation can be done is when the victim is brought to the hospital emergency room immediately or when an ambulance arrives instantly.

The value of early CPR is that it can "buy time" by maintaining some blood flow to the heart and brain during an arrest until such time that defibrillation and advance life support measures are available. In an effort to reduce barriers to the performance of CPR by lay bystanders, the CPR Council of the Philippine Heart Association started its promotion of chest compression only or hands only CPR in its basic life support courses for lay in 2010. This was done in accordance to recommendations from the American Heart Association Emergency Cardiovascular Care Committee. The Council has also jumpstarted its program of increasing awareness on the use of the automatic external defibrillator through skills and competence training for lay responders and healthcare providers.

CPR can be learned by anyone. It requires no special medical skills and training is available for the ordinary person nationwide. Furthermore, knowledge of what to do in case of emergencies is important. This includes immediate activation of the emergency medical system in the area, call for an ambulance or medical assistance. Short courses on basic life support techniques which include CPR are worthwhile and may be inquired through the PHA.